The volatility of respiratory symptoms due to asthma is related in large measure to the dynamic nature of airway obstruction in this disease. The ability to detect airway obstruction early respiratory interoception helps individuals with asthma to manage their symptoms, to decide when to take inhaled medications. Impaired respiratory interoception, conversely, commonly delays treatment and impedes clinicians decisions regarding inhaled medicine. We developed breath-controlled video games as a means of pulmonary rehabilitation for individuals with chronic lung disease. Our experience with this approach in patients with cystic fibrosis shows that adolescents not only enjoy using a spirometer (a device traditionally used to measure inspiratory and expiratory flow rates) as a video game controller when playing an eye breath coordination task but they also learn to improve breath awareness. This finding has encouraged us to apply the breath-controlled video game approach to the problem of impaired respiratory interoception in asthma. Here we propose to further develop hardware and software for breath-controlled videogames that will function as an adjunct to respiratory therapy in asthma as well as for other chronic respiratory diseases. Programming of breath-controlled video games will incorporate a breath biofeedback educational process that promotes breath awareness by presenting the player with modulated representations of their own breathing patterns (Breath Biofeedback System and Method, US Patent pending). We will design and prototype a breath-game controller modeled after digital spirometers used for clinical diagnosis. Hardware and software assets created through this project will be used in a field trial of the effect of breath- controlled video games may also favorably impact asthma-related quality of life, as well as technique in, and adherence to, self-administration of inhaled medications. By embedding explicit educational messages within breath-controlled games, we expect this approach to promote self-management and effective use of health care resources on several levels. This project will also provide a foundation for studies of breath-controlled video games for adults with chronic obstructive pulmonary disease. PUBLIC HEALTH RELEVANCE: Mis-perception of asthma symptoms represents a common problem for millions of individuals who suffer this chronic respiratory condition. For unknown reasons, those with the most dangerous kind of asthma have the most difficulty with sensing the severity of their airway obstruction. In this project we develop technology for a novel, "breath-controlled video game" that will improve awareness of symptoms, and of respiratory wellness, in people with asthma.